Gender Differences in Use of Prolonged Nonoperative Therapies Before Index Lumbar Surgery

Mark A. Davison, Victoria D. Vuong, Daniel T. Lilly, Shyam A. Desai, Jessica Moreno, Joseph Cheng, Carlos Bagley, Owoicho Adogwa

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20.9 million covered lives and includes private or commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the Humana insurance system for ≥5 years before the index operation were eligible. Usage was characterized by the cost billed to the patient, prescriptions written, and number of units billed. Results: A total of 4133 patients (58.5% women) underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. A significantly greater percentage of female patients used nonsteroidal anti-inflammatory drugs (P < 0.0001), lumbar epidural steroid injections (P = 0.0044), physical and/or occupational therapy (P < 0.0001), and muscle relaxants (P < 0.0001). The total direct cost associated with all maximal nonoperative therapy before index spinal fusion was $9,000,968, with men spending $3,451,479 ($2011.35 per patient) and women spending $5,549,489 ($2296.02 per patient). When considering the quantity of units billed, women used 61.5% of the medical therapy units disbursed despite constituting 58.5% of the cohort. When normalized by the number of pills billed per patient using therapy, female patients used more nonsteroidal anti-inflammatory drugs, opioids, and muscle relaxants. Conclusions: These results suggest that gender differences exist in the use of nonoperative therapies for symptomatic lumbar stenosis or spondylolisthesis before fusion surgery.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Spondylolisthesis
Therapeutics
Spinal Fusion
Pathologic Constriction
Insurance
Costs and Cost Analysis
Anti-Inflammatory Agents
Medicare Part C
Databases
Epidural Injections
Muscles
Occupational Therapy
Decompression
Pharmaceutical Preparations
Opioid Analgesics
Prescriptions
Steroids

Keywords

  • Conservative treatment
  • Lumbar spine
  • Opioid analgesics
  • Preoperative care
  • Spinal stenosis
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Davison, M. A., Vuong, V. D., Lilly, D. T., Desai, S. A., Moreno, J., Cheng, J., ... Adogwa, O. (Accepted/In press). Gender Differences in Use of Prolonged Nonoperative Therapies Before Index Lumbar Surgery. World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.08.131

Gender Differences in Use of Prolonged Nonoperative Therapies Before Index Lumbar Surgery. / Davison, Mark A.; Vuong, Victoria D.; Lilly, Daniel T.; Desai, Shyam A.; Moreno, Jessica; Cheng, Joseph; Bagley, Carlos; Adogwa, Owoicho.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Davison, Mark A. ; Vuong, Victoria D. ; Lilly, Daniel T. ; Desai, Shyam A. ; Moreno, Jessica ; Cheng, Joseph ; Bagley, Carlos ; Adogwa, Owoicho. / Gender Differences in Use of Prolonged Nonoperative Therapies Before Index Lumbar Surgery. In: World Neurosurgery. 2018.
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abstract = "Objective: The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20.9 million covered lives and includes private or commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the Humana insurance system for ≥5 years before the index operation were eligible. Usage was characterized by the cost billed to the patient, prescriptions written, and number of units billed. Results: A total of 4133 patients (58.5{\%} women) underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. A significantly greater percentage of female patients used nonsteroidal anti-inflammatory drugs (P < 0.0001), lumbar epidural steroid injections (P = 0.0044), physical and/or occupational therapy (P < 0.0001), and muscle relaxants (P < 0.0001). The total direct cost associated with all maximal nonoperative therapy before index spinal fusion was $9,000,968, with men spending $3,451,479 ($2011.35 per patient) and women spending $5,549,489 ($2296.02 per patient). When considering the quantity of units billed, women used 61.5{\%} of the medical therapy units disbursed despite constituting 58.5{\%} of the cohort. When normalized by the number of pills billed per patient using therapy, female patients used more nonsteroidal anti-inflammatory drugs, opioids, and muscle relaxants. Conclusions: These results suggest that gender differences exist in the use of nonoperative therapies for symptomatic lumbar stenosis or spondylolisthesis before fusion surgery.",
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AU - Davison, Mark A.

AU - Vuong, Victoria D.

AU - Lilly, Daniel T.

AU - Desai, Shyam A.

AU - Moreno, Jessica

AU - Cheng, Joseph

AU - Bagley, Carlos

AU - Adogwa, Owoicho

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AB - Objective: The purpose of the present study was to assess for gender-based differences in the usage and cost of maximal nonoperative therapy before spinal fusion surgery in patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures from 2007 to 2016. This database consists of 20.9 million covered lives and includes private or commercially insured and Medicare Advantage beneficiaries. Only patients continuously active within the Humana insurance system for ≥5 years before the index operation were eligible. Usage was characterized by the cost billed to the patient, prescriptions written, and number of units billed. Results: A total of 4133 patients (58.5% women) underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. A significantly greater percentage of female patients used nonsteroidal anti-inflammatory drugs (P < 0.0001), lumbar epidural steroid injections (P = 0.0044), physical and/or occupational therapy (P < 0.0001), and muscle relaxants (P < 0.0001). The total direct cost associated with all maximal nonoperative therapy before index spinal fusion was $9,000,968, with men spending $3,451,479 ($2011.35 per patient) and women spending $5,549,489 ($2296.02 per patient). When considering the quantity of units billed, women used 61.5% of the medical therapy units disbursed despite constituting 58.5% of the cohort. When normalized by the number of pills billed per patient using therapy, female patients used more nonsteroidal anti-inflammatory drugs, opioids, and muscle relaxants. Conclusions: These results suggest that gender differences exist in the use of nonoperative therapies for symptomatic lumbar stenosis or spondylolisthesis before fusion surgery.

KW - Conservative treatment

KW - Lumbar spine

KW - Opioid analgesics

KW - Preoperative care

KW - Spinal stenosis

KW - Spondylolisthesis

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